Welcome to our media digest for the week ending June 1, 2018! Each week, PI compiles a round-up of the latest public health-related news, with an eye toward media framing and language, particularly as they relate to the role of primary prevention. The views expressed in these articles do not reflect those of Prevention Institute.

A study published this week in the New England Journal of Medicine estimates that over 4,600 Puerto Ricans may have died in the aftermath of Hurricane Maria. Vox summarizes key findings: “The new estimate of 4,600 “excess deaths” occurring between September 20, the day Hurricane Maria made landfall on Puerto Rico, and December 31 stands in stark contrast to the government’s official count of 64, a gross underestimate that has remained unchanged for months. The new research also validates previous analyses of mortality data and reports from the ground by journalists and other researchers that found that the death toll was well over 1,000… Alexis Santos, a Puerto Rican demographer at Penn State who conducted his own analysis of mortality following the hurricane, told Vox the study’s methodology was consistent with how other scholars have tried to measure the death toll. ‘Under the level of devastation experienced following Hurricane Maria it is very difficult to separate deaths from the environmental or contextual conditions, one may even say that Hurricane Maria impacted all of the deaths that occurred during that period… That is why approaching it through the perspective of excess deaths provides a figure that excludes the deaths that would have happened under normal conditions.’” Many deaths were attributed to lack of access to medical care in the weeks after the storm. The Washington Post attempted to estimate preventable deaths and reported that “among those deaths linked to the hurricane by survey respondents, the number linked to issues with receiving medical care outnumbered direct deaths by a 4-to-1 margin. If that ratio held for all 4,645 reported deaths, it would suggest that more than 3,700 people died as a result of a lack of access.Such problems apparently were widespread. Setting aside the rampant issues with access to electricity and water, nearly 15 percent of households indicated that for at least some period of time, they’d been unable to access medicine. About 10 percent said they were unable to use respiration equipment. Slightly fewer cited damaged roads and closed facilities as impediments to getting medical care for at least some part of the period between the storm and the end of the year.”

Tobacco companies have poured over $11.5 million to defeat San Francisco’s Proposition E. If approved by voters, Prop E would ban flavored tobacco products, including menthol products and flavored e-cigarette cartridges. The San Francisco Examiner reports, “Tobacco companies have a long history of developing and marketing flavored tobacco products as ‘starter’ products that attract kids,” Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said via email. “These products come in flavors like gummy bear, cotton candy and banana smash that clearly appeal to kids, and they’re often colorfully packaged to look just like candy and other kid-friendly products.” Marketers also target minorities and the LGBT community, according to proponents, who say tobacco products have burdened The City with costs including increased health care costs due to tobacco-related illness. In 2009, the estimated cost of tobacco product litter in San Francisco came to nearly $7.5 million, according to a Health Economics Consulting Group LLC report.”

A Vox article explores the privatization of public space and movements to demand public rights in privately owned spaces like Starbucks.“In many cities, the obligation to provide public services, like bathrooms, has been so utterly abandoned that we must rely on private businesses to fill the gaps. Second, the negotiations that then take place, in which we feel obligated to make a commodity exchange just to live our lives, is demeaning and frustrating for all parties… In today’s “global” cities, if you can’t pay, you’re not invited to participate…The treatment of these two men at Starbucks, as well as the social backlash that followed, raises an important issue about what rights we should have as citizens in private spaces that, increasingly, are the closest thing we have to public spaces. At different times in the past, and in other parts of the world, our public lives would take place in squares, gardens, beaches, and parks. Often now, when we seek those spaces, what we find instead are spaces built only for consumption. “An environment is also an inward reality,” the social critic James Baldwin once wrote. “It’s one of the things which makes you, it takes from you and it gives to you, facts which are suggested by the word itself.” Baldwin would undoubtedly be concerned today about how the increasingly privatized environment in which many of us live our lives is shaping our actions, expectations, and desires.”

Illinois became the 37th state to ratify the Equal Rights Amendment, which states that the “equality of rights under the law shall not be denied or abridged by the United States or by any state on account of sex,” 46 years after it was sent to the states for ratification (and 36 years after the deadline Congress set for states to ratify the amendment).

Rewire.News examines some of the potential contributors to high suicide rates among veterans in Appalachia, including social isolation, stigma around talking about mental health, limited access to mental health providers, and substance misuse linked to prescriptions of high-dosage opioids. Among the promising solutions: veterans helping veterans. As a National Guardsman put it: “…the whole listening, sharing, understanding with people you already know, love, and trust—with no pressure to solve something—is just most comforting.”

When a neighbor called 911 to report a Black real estate investor who was removing boards from a property in Memphis, the realtor recorded the incident on a video that subsequently went viral, one of a number of similar recorded experiences featured in the #LivingWhileBlack movement, The Washington Post reports.

Americans with serious mental health conditions are more likely to die earlier, often as a result of physical problems like cancer, heart disease, stroke, and diabetes, Dr. Dhruv Khullar writes in The New York Times. The gap in early death rates for people with conditions such as depression, bipolar disorder, and schizophrenia are more pronounced than disparities in death rates linked to race, socioeconomic status, and geography, according to Dr. Khullar. In addition, he writes, “Those with serious mental illness are more likely to struggle with homelessness, poverty and social isolation. They have higher rates of obesity, physical inactivity and tobacco use. Nearly half don’t receive treatment, and for those who do, there’s often a long delay.” Dr. Khullar suggests that in some cases, physicians’ pessimism about the patients’ outlook may lead them to overlook physical problems, and in others, they mistakenly attribute physical complaints to patients’ mental states. Meanwhile, a study out of Denmark published in JAMA finds that people with serious mental health conditions are at greater risk of being victims of violent crimes. Those with the most elevated risks are women with substance misuse disorders, the study found. The study also showed links between committing crimes and being crime victims.

A new report from Save the Children finds that one billion children live in areas of widespread poverty, 240 million live in areas experiencing armed conflict (with 28 million children forcibly displaced from their homes), and 575 million girls live in countries where sex-based violence and discrimination are widespread.

Pacific Standard magazine profiles community groups working to address community trauma that results from experiencing and witnessing police violence in their communities. Among them is the Anti Police-Terror Project in Oakland, which has established a first responders’ committee that conducts independent investigations and provides a healing space for community members.